An orthopedic-, surgical-, and epidemiological-based investigation of leprosy, in the Tamil Nadu state of India.

No other research paper has ever been written about leprosy in this manner. The orthopedic and surgical implications, as well as the functional debility caused by the disease, have not been previously explained by past research as they have in such a comprehensive manner in this paper. The results of this study have regional and global implications as they pertain to disease pathology, risk factor recognition/disease prevention, and treatment. This paper is a unique, in that it also serves as a combination of a review of the current medical literature, as well as an epidemiological survey of the disease in a region of the world which has never been researched in the past. Clinical data points to the possibility of a new strain of the disease. This information is of significance because it effects prevention and improved treatment of the disease, which leads to devastating sequela. This was a cross-sectional study involving subjects diagnosed with leprosy in the Chengalpet region of the Kancheepuram District, of the Tamil Nadu state of India. The study was performed at the Tamil Nadu Medical College Teaching Hospital and Research Center. This study included various physical examinations, observation and survey of lesions, questionnaires in regard the debilitating orthopedic and medical effects of the disease, as well as treatment options.

Correlation of clinical and histopathological classification of leprosy in post elimination era.

Clinical and histopathological correlative study was carried out in 171 cases of leprosy using the criteria laid down by Ridley and Jopling. There was male preponderance in the study with majority of patients (35.7%) in the age goup of 21-30 years. The overall concordance between the clinical and histopathological diagnosis was 57.3%. Maximum concordance was seen in the polar ends of the spectrum with 76.9% in LL and 75.0% in TT. The concordance rate was lower in the borderline groups with 57.3% in BT, 40.0% in BL and least concordance of 16.7% in BB. However the concordance for IL was higher than the borderline groups with 66.7%. Cases in borderline group are in continuously changing immunological spectrum. Histological classification because of its definitive features gives a better indication than clinical classification for any recent shift of a case in the spectrum. Therefore skin biopsy should be done in all cases for correct classification of leprosy.

Sero-epidemiological study of kala-azar in a village of Varanasi district, India.

OBJECTIVE: To evaluate five kala-azar serological tests for field use. METHOD: Serological survey in Pandit Ka Purva village in Varanasi district, India, using Sia water test, aldehyde test, direct agglutination test (DAT), micro-enzyme-linked immunosorbent assay (ELISA) and dot-ELISA. RESULTS: The total population of the village was 518, 67 of whom showed typical clinical and parasitological features of kala-azar, including seven who died. The age distribution of kala-azar cases showed significant differences, being highest among the 45-54-year age group. The disease was more prevalent among males. Serum samples were collected from 498 persons (96% of total population) including 67 kala-azar cases and 40 disease controls (malaria, TB, leprosy, typhoid). Ten 10 serum samples from healthy controls living in endemic area were also collected. The test sensitivities were: Sia water test, 85.0%; aldehyde test, 62.7%; DAT, 94.0%; micro-ELISA, 91.0% and dot-ELISA, 97.0%. The test specificities were: Sia water test 92.5%, aldehyde test, 93.2%, DAT, 96.7; micro-ELISA, 97.6% and dot-ELISA, 98.4%. CONCLUSION: The dot-ELISA is highly sensitive and specific, cheap, and easy to interpret with the naked eye, making it a powerful screening test for the surveillance and diagnosis of Indian kala-azar at field level.

Meshed split skin graft for extensive vitiligo.

A 30 year old female presented with generalized stable vitiligo involving large areas of the body. Since large areas were to be treated it was decided to do meshed split skin graft. A phototoxic blister over recipient site was induced by applying 8 MOP solution followed by exposure to UVA. The split skin graft was harvested from donor area by Padgett dermatome which was meshed by an ampligreffe to increase the size of the graft by 4 times. Significant pigmentation of the depigmented skin was seen after 5 months. This procedure helps to cover large recipient areas, when pigmented donor skin is limited with minimal risk of scarring. Phototoxic blister enables easy separation of epidermis thus saving time required for dermabrasion from recipient site.

Clinicohistological disparity in leprosy.

A healthy elderly man presented with localized isolated erythematous tender, anesthetic, oval plaque with little scaling near the medial angle of right eye, of 3 years' duration without any obvious nerve thickening, treated irregularly with WHO MDT for 3 months, clinically simulating BT leprosy with downgrading reversal reaction. Histology showed a BL granuloma with plenty of solid staining AFB within the foamy macrophages. Lepromin test was very weakly positive. The case is discussed in the light of clinicohistological disparity in leprosy cases with review of relevant literatures. A stress is laid on the importance of newer MDT in such cases to prevent drug-resistance, relapse and recurrence.

Epidemic dropsy: a study of cutaneous manifestations with histopathological correlation.

Clinical and histopathological features of epidemic dropsy were studied in 19 patients. Bilateral pitting pedal oedema, erythrocyanosis and tachycardia without fever were the predominant clinical features. Histology revealed deposition of hyaline material on the walls of dermal blood vessels.

Histopathological correlation of skin biopsies in leprosy.

Histopathological correlation of skin biopsies in 372 leprosy patients was done with clinical diagnosis using Ridley Jopling classification. There was agreement in 62.63% of cases. The correlation was highest in LL (80%) followed by Bl. (70%), BT (66.34%), BB (50%) and TT (46.15%). The other interesting observation was that the number of IL cases diagnosed histopathologically were more when compared to that made clinically.

Proliferating trichilemmal cyst mimicking squamous cell carcinoma.

A proliferating trichilemmal cyst of long standing duration, with its sudden increase in size and ulceration was clinically suspected to be a squamous cell carcinoma. Microscopic features revealed the appropriate diagnosis.

Pattern of skin diseases in Bantwal Taluq, Dakshina Kannada.

A survey was conducted to find out the pattern of skin diseases among patients who attended the fortnightly medical camp held in Bantwal Taluq, a rural area. Infective disorders were found in 42.68% and non infective in 41.58%. Among the infective disorders fungal infections were most common (24.08%). Among the non infective dermatoses eczemas were most common (33.93%). On comparing the proportional infectivity rate of infectious diseases among males and females it was found that in scabies males were more affected than females.

Non-arthropathic psoriasis associated with uveitis.

A patient with non-arthropathic psoriasis and associated uveitis is reported.

Role of laser therapy in post herpetic neuralgia.

The efficacy of combi laser therpay was evaluated in fifty cases of post neuralgia (PHN) of different age groups (31 to 81 years) and with varying duration of illness from 2 months to 4 and a half years in the present study. The affected areas were irradiated from a distance of 5 cms. using the probe of 12x70 watts at a frequency of 1000 Hz. each area being exposed for a time period of 5 minutes and 6 seconds. In each case the combi laser therapy was given for 15 consecutive days and therapeutic effect of the therapy was evaluated after 5th, 10th and 15th laser application during the treatment with the help of visual analouge scale (VAS). Patients started responding to the therapy after an average of 3.28 laser applications and VAS steadily decreased as the therapy progressed. After completion of therapy, 43 (86%) out of 50 cases showed excellent relief (76-100%) and remaining 7 (14%) cases showed partial relief, 4(8%) cases with good relief (51-75%), 2 (4%) cases with fair relief (26-50%) and 1(2%) case with poor relief (1-25%). Partial relief in our 7 cases could be due to multiple factors like prolonged duration of illness, involvement of ophthalmic division of trigeminal nerve and formation of scarring and keloids. No side effects were observed during the treatment as well as duing the follow up period of 8 weeks.

Prevalence of various dermatoses in school children.

In a school survey of 1161 children from 2 different schools studying in 1st to 5th standard between the age of 6 and 12 years, 890 (76.65%) students were found to have disorders of skin and its appendage. Most of the dermatoses were asymptomatic and were diagnosed in the routine examination. Nevoid conditions were seen in 255 (21.96%) students. Communicable dermatoses were noted in 221 (19%) students and nutritional deficiencies were seen in 78 (6.71%) students. Rest of the students had miscellaneous condition. Health education and good personal hygiene will definitely help to improve the health status of the school children.

Dermatoses of the hand-an observation.

After going through 1000 case files of patients registered in the skin department of K.M.C. Hospital, it was found that 166 (16.6%) of them had dermatoses restricted to their hands. Based on the clinical findings and clinical diagnosis recorded, the various dermatoses were tabulated and evaluated. Ninety-two males and 74 females had dermatoses of hands. Warts and eczemas formed the major chunk of cases. Females out numbered males among patients with warts and eczemas.

Congenital erythropoietic porphyria associated with ventricular septal defect.

A case of congenital erythropoietic porphyria associated with ventricular septal defect in a 6-year-old girl is reported.

Peripheral nerve abscess in leprosy: report of twenty cases.

During the year 1994-1995, 20 of the 67 leprosy patients attending the dermatology department with any kind of nerve involvement were found to be having nerve abscess. These abscesses occurred in all types of leprosy (except the Indeterminate) and a variety of nerve trunks and cutaneous nerves. In none of the instances the abscess was associated with reaction. All the patients were surgically treated, without any steroid therapy. All cases showed significant improvement whenever there was nerve function deficit. Similarly, pain was relieved in all cases, when it was present.